2022 What we will cover State Health Plan overview PEBA Perks Adult well visits Health and wellness benefits Online tools and resources 2 State Health Plan Selffunded insurance plan Members and employers premiums are held in a trust fund and these funds are used to pay claims ID: 933188
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Slide1
Health and Wellness:Your Benefits Resources
2022
Slide2What we will cover
State Health Plan overview.
PEBA Perks.
Adult well visits.Health and wellness benefits.Online tools and resources.
2
Slide3State Health Plan
Self-funded insurance plan:
Members’ and employers’ premiums are held in a trust fund, and these funds are used to pay claims.
BlueCross BlueShield of South Carolina processes health claims. Express Scripts processes prescription claims.
Cost of the State Health Plan compares favorably to other plans.
Learn more at
peba.sc.gov/facts.Health management is key to maintaining a low cost for the Plan and premiums.
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Slide4PEBA Perks
4
Value-based benefits at no cost
Slide5Value-based benefits available at no cost to State Health Plan primary members at network providers and pharmacies.
Benefits can help make it easier for you and your family to stay healthy.
www.PEBAPerks.com
.
Preventive screenings.
Flu vaccine.
Adult vaccinations.Well child benefits (exams and immunizations).Colorectal cancer screening.Cervical cancer screening.No-Pay Copay.
Mammography.
Diabetes education.
Tobacco cessation.
Breast pumps.
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PEBA Perks
Slide6Preventive screenings
Available to State Health Plan primary subscribers, non-Medicare eligible retirees, COBRA subscribers and covered spouses.
Screenings, worth more than $300, include:
Blood work;
Health risk appraisal;
Height and weight measurements;
Blood pressure check; and Lipid panels.Share your preventive screening results with your network provider to eliminate the need for retesting at a well visit.
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Slide7Flu vaccine
Available to State Health Plan primary members.
Members may get the shot from a participating network pharmacy for a $0 copay.
Children ages 3 and older can receive a flu shot at a network pharmacy.If a member receives the shot at a network doctor's office, the vaccine and the administration fee will be covered at no cost.
Any costs associated with the office visit will be processed according to regular Plan coverage rules.
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Slide8Adult vaccinations
Available to State Health Plan primary members.
Covered as recommended by the
U.S. Centers for Disease Control and Prevention.If a member receives a shot at a network doctor's office, the vaccine and the administration fee will be covered at no cost.
Any costs associated with the office visit will be processed according to regular Plan coverage rules.
Members can also take advantage of this benefit at a network pharmacy.
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Slide9Well child benefits
Available to covered dependents through age 18.
Plan pays 100 percent of the allowed amount for approved exams and immunizations at a network provider.
American Academy of Pediatrics recommends services at certain ages.
U.S. Centers for Disease Control and Prevention
recommends immunizations.
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Slide10Colorectal cancer screening
Available to State Health Plan primary members at a qualified network provider.
Routine screening covered based on age range recommended by the
United States Preventive Services Task Force.
Eligible members can also opt for some take-at-home tests.
Diagnostic screenings available at any age.
Benefit covers only pre-surgical consultation, generic prep kit, procedure and anesthesia.Any associated lab work as a result of the screening will be processed according to normal Plan provisions.
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Slide11Cervical cancer screeningAvailable to State Health Plan primary women ages 18-65.
Covers a Pap test each calendar year at no cost.
Benefit covers only the lab fee and portion of the office visit associated with the Pap test.
Based on the recommendation of the United States Preventive Services Task Force, the Plan will pay a benefit for HPV testing once every five years for women ages 30-65, or as otherwise recommended by the USPSTF.
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Slide12No-Pay Copay
Available to State Health Plan primary subscribers and covered spouses.
Qualify for the program on a quarterly basis through Rally by completing certain quarterly and annual activities.
Receive certain generic medications for the following conditions:High blood pressure and high cholesterol;
Cardiovascular disease, congestive heart failure and coronary artery disease; and
Diabetes.
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Slide13Mammography
Available to State Health Plan primary women.
One baseline routine mammogram (four views) for women ages 35-39.
One routine mammogram (four views) each calendar year for women ages 40 and older.Diagnostic mammograms are processed according to regular Plan coverage rules.
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Slide14Diabetes education
Available to State Health Plan primary members.
Diabetes education helps diabetics understand their condition and how to better manage it.
People who receive diabetes education are more likely to Use primary care and preventive services;
Take medications as prescribed; and
Control their blood glucose, blood pressure and cholesterol levels.
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Slide15Tobacco cessation
Available to State Health Plan primary subscribers and covered spouses and dependent children ages 13 or older.
Enroll in Quit For Life® program at
www.quitnow.net/SCStateHealthPlan or 800.652.7230.Includes a $0 copay for eligible tobacco cessation medications to eligible participants.
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Slide16Breast pumps
Available to State Health Plan primary women.
Receive certain electric or manual breast pump.
Learn more by enrolling in Coming Attractions.Log in to your My Health Toolkit
account. Select Wellness, then Health Coaching.
Call 803.699.3337 or 800.925.9724.
Coming Attractions program supports mothers throughout pregnancy and baby’s first year of life.Lactation consultations are available at no cost through Blue CareOnDemand.
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Slide17Adult well visits
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Slide18Adult well visits covered by Standard PlanCovered as a contractual service by the Standard Plan.
Visit is subject to copayment, deductible and coinsurance.
Evidence-based services, with an A or B recommendation by the
United States Preventive Services Task Force (USPSTF), included.
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Slide19Adult well visit eligibility for Standard Plan membersAvailable to all non-Medicare primary adults ages 19 and older.
The Standard Plan will cover only one visit in covered years based on the following schedule:
Eligible female members may use well visit at gynecologist or primary care physician, but not both, in a covered year.
If a female visits both doctors in the same covered year, only the first routine office visit received will be allowed.
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Once a year
Once every
two years
Once every
three years
Ages 19-39
Ages 40-49
Ages 50 a
nd up
Slide20Adult well visit for Savings Plan membersIncludes evidence-based services with an A or B recommendation by the
United States Preventive Services Task Force
(USPSTF).
Savings Plan will cover one well visit each year for members at no member cost.20
Slide21Where to go for an adult well visit
Take advantage of this benefit at a network provider specializing in:
General practice;
Family practice;Pediatrics;Internal medicine; Gerontology; orObstetrics and gynecology.
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Slide22Services not included as part of an adult well visitThose without an A or B recommendation by the USPSTF.
Other services, including a complete blood count (CBC), EKG, PSA test and basic metabolic panel, if ordered by a physician to treat a specific condition, are subject to the copayment, deductible and coinsurance, as well as normal Plan provisions.
Follow-up visits and services as a result of a well visit are also subject to normal Plan provisions.
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Slide23How to get the most out of your benefits
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Slide24Health and wellness benefits24
Slide25Patient-centered medical home (PCMH)
Focus is on coordinating care and preventing illnesses rather than waiting until an illness occurs and treating it.
Standard Plan members do not pay the $14 copayment for an in-person physician office.
Members pay a 10 percent coinsurance for an in-person office visit, rather than 20 percent coinsurance, once meeting their deductible.Learn more and find a list of PCMH providers at www.StateSC.SouthCarolinaBlues.com
.
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Slide26Blue CareOnDemandAvailable to State Health Plan primary members ages 18 and older.
Dependent children can use the benefit with an adult member.
Connect with health care professionals via computer or smartphone 24/7/365.
Maximum cost of $59.Cost is subject to regular Plan coverage rules, including annual deductible and coinsurance.peba.sc.gov/telehealth.
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Slide27Health issues appropriate for a Blue CareOnDemand visit
Cold and flu symptoms.
Allergies.
Bronchitis and other respiratory infections.Urinary tract infections.Rashes and other skin irritations.Sinus problems.Migraines.Pinkeye.
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Slide28Other types of Blue CareOnDemand visitsBehavioral health:
Video chat with a licensed counselor, therapist, psychologist or psychiatrist from the comfort of your home.
Schedule follow-up visits at the time and frequency that are right.
Cost of the visit will vary based on the type of provider.Lactation consultations:Video chat with a lactation consultant at no cost and get help for many of the common issues associated with breastfeeding. Schedule follow-up appointments at a time and frequency that are right.
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Slide29MUSC Health Virtual Care
State Health Plan members, including Medicare-primary members, have access to MUSC’s telehealth option at no cost.
Opt
for non-video visits or video visits.Common conditions treated include allergies, pinkeye, sinus infections, skin rashes, sore throat, urinary tract infections and flu.
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Slide30MUSC Health Virtual Care
A member does not need to be a South Carolina resident; however, a member must be in South Carolina at the time of the visit.
Members ages 18 and older can create an account.
Members can also add dependents to their account. Visits for dependent children younger than age 18 must be completed by a parent.
peba.sc.gov/telehealth
.
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Slide31Lower copayment for preferred insulin
The Patient Assurance Program enables State Health Plan members to get a 30-day supply of preferred and participating insulin products for $25 (90-day supply for $75) at a network pharmacy or through home delivery from Express Scripts Pharmacy.
See if your insulin medication is eligible for the reduced copayment by logging in to your account at
express-scripts.com
or by calling 855.612.3128.
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Slide32Wondr HealthTeaches it’s not what you eat, but when and how you eat that will help you lose and keep off weight.
10-week online program using video lessons and interactive tools.
Participants watch lessons at their convenience on their computer, smartphone or tablet through iPhone or Android apps.
Following the first 10 weeks, participants will receive:Seven biweekly sessions; and Six months of continued support, as needed.
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Slide33Wondr Health eligibilityAvailable at no cost to members.
Includes first 10 weeks, seven biweekly sessions and six months of continued support.
State Health Plan members ages 18 and older can apply to participate. Also available to Medicare-primary members.
Some medical conditions or body mass indexes (BMIs) may prevent you from participating in the program. Apply for an upcoming program at wondrhealth.com/PEBA
.
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Slide34RallyDigital health platform that offers State Health Plan primary members ages 16 and older a personalized experience.
Link certain wearable devices to Rally.
Find your Rally Age, track your movement, complete missions and compete with others in challenges.
Register by logging in to your My Health Toolkit account. Select Wellness, then Rally.
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Slide35Health coachingAvailable to State Health Plan subscribers and covered adult family members.
Designed to help those with behavioral or chronic medical conditions.
Automatically enrolled if identified through claims as someone who could benefit from one of the programs.
Can opt out at any time.To self-enroll, call BlueCross at 855.838.5897.peba.sc.gov/health-coaching.
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Slide36Online tools and resources36
Slide37Navigating Your Benefitspeba.sc.gov/
nyb
.
Plain-language explanations of insurance and retirement benefits.Flyers and videos.37
Slide38Member messagingText messages that can help you stay on top of your health.
Receive benefits information, health and wellness reminders and cost-saving tips.
Two ways to sign up:
Call 844.284.5417.Text PERKS to 735-29.38
Slide39My Health ToolkitOne-stop destination to manage your health benefits.
Learn more about your coverage.
Check medical and dental claims.
Manage your prescriptions.Replace or view your identification card.Find a doctor or hospital.Improve your wellness with Rally.Download the mobile app to register or visit
www.StateSC.SouthCarolinaBlues.com
.
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Slide40How to register for My Health Toolkit
Search My Health Toolkit in your app store.
In the app, select Sign Up. You can also visit
www.StateSC.SouthCarolinaBlues.com and select Create An Account.Enter your member identification number on your State Health Plan identification card and your date of birth.
Choose a username and password.
Enter your email address and choose to go paperless.
For enhanced security, multi-factor authentication is required. If you have any questions about your My Health Toolkit account, call BlueCross at 877.274.1715.
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Slide41My Health Toolkit: for your entire familySubscribers, covered spouses and dependents ages 16 and older can create their own profile.
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Who can see information
Subscriber’s
c
laims/eligibility
Spouse’s
claims/eligibility
Dependent’s
claims/eligibility
Subscriber
Spouse
Dependent(s)
Slide42Manage your medicine with taps, not trips.Register at
www.express-scripts.com
or download the Express Scripts mobile app.
Online tools include:See prescription drug claims and payment history.Check if a drug requires prior authorization and compare drug prices.Locate a network pharmacy near you.Access your identification card.
View information about the COVID vaccine if received at a network pharmacy.
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Slide43MyBenefitsMyBenefits.sc.gov
.
Accessible online 24/7.
Review benefits statement;Change contact information;Update life insurance beneficiaries;Change coverage during some special eligibility situations;Make changes during open enrollment; and
Upload supporting documentation.
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Slide44Questions?
Visit us online at
peba.sc.gov
.Call PEBA’s Customer Service at 803.737.6800 or 888.260.9430.For questions about health claims, call BlueCross at 800.868.2520.For questions about prescription claims, call Express Scripts at 855.612.3128.
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